Obstetrics and Gynecology Department, Tenon Hospital, Assistance Publique des Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France.
Neurourol Urodyn. 2012 Jan;31(1):126-31. doi: 10.1002/nau.21117. Epub 2011 Sep 26.
To compare changes in urinary symptoms before and after pelvic organ prolapse (POP) surgery, using either laparoscopic sacrocolpopexy (LSC) or transvaginal porcine dermis hammock placement with sacrospinous ligament suspension (VS).
Data were prospectively collected from all women undergoing POP surgery between May 2001 and October 2009. Pre- and postoperative urinary symptoms, Urinary Distress Inventory (UDI), and Urinary Impact Questionnaires (UIQ) scores were compared within and between groups. A generalized linear model was used for multivariate analysis.
Out of the 151 patients included, 87 patients underwent LSC, and 64 VS. Overall, after a median follow-up of 32.4 months, POP surgery improved urinary frequency (P = 0.006), voiding difficulty (P = 0.001), stress urinary incontinence (SUI) (P = 0.001), but not urgency (P = 0.29). VS was more effective in treating SUI (P < 0.001 vs. 0.52) while LSC more effective on voiding difficulty (P = 0.01 vs. 0.08). Postoperative de novo symptoms were observed in 35.8% of patients with no difference between the groups (P = 0.06). UDI (P = 0.04) and UIQ (P = 0.01) scores were significantly lower after surgery. However, LSC significantly improved UDI (P = 0.03) with no effect on UIQ (P = 0.29) scores while VS significantly improved both scores (P = 0.02 and 0.001, respectively). Upon multivariate analysis, only the improvement in the impact of urinary symptoms on daily living was independently associated to VS (OR = 5.45 [95% confidence interval 2.20-13.44], P = 0.01).
Most preoperative urinary symptoms decreased after POP surgery with equivalent proportion of de novo symptoms after vaginal and laparoscopic approaches.
比较经阴道补片置入联合骶棘韧带悬吊术（VS）与腹腔镜骶骨阴道固定术（LSC）治疗盆腔器官脱垂（POP）前后的尿症状变化。
前瞻性收集 2001 年 5 月至 2009 年 10 月间所有接受 POP 手术的女性患者的数据。比较组内和组间术前和术后的尿症状、尿失禁困扰量表（UDI）和尿失禁影响问卷（UIQ）评分。采用广义线性模型进行多变量分析。
共纳入 151 例患者，其中 87 例行 LSC，64 例行 VS。总体而言，中位随访 32.4 个月后，POP 手术改善了尿频率（P = 0.006）、排尿困难（P = 0.001）和压力性尿失禁（SUI）（P = 0.001），但对急迫性尿失禁（P = 0.29）无影响。VS 治疗 SUI 更有效（P < 0.001 vs. 0.52），而 LSC 对排尿困难更有效（P = 0.01 vs. 0.08）。术后新发症状见于 35.8%的患者，两组间无差异（P = 0.06）。术后 UDI（P = 0.04）和 UIQ（P = 0.01）评分显著降低。然而，LSC 显著改善了 UDI（P = 0.03），但对 UIQ 评分无影响（P = 0.29），而 VS 显著改善了这两个评分（P = 0.02 和 0.001）。多变量分析显示，只有 VS 与尿症状对日常生活影响的改善独立相关（OR = 5.45 [95%置信区间 2.20-13.44]，P = 0.01）。
POP 手术后大多数术前尿症状均减轻，阴道和腹腔镜方法术后新发症状比例相当。
